When a member of Congress introduces legislation, the
Constitution requires that legislative proposal to secure the
approval of the House of Representatives, the Senate, and the
president (unless Congress overrides a presidential veto) before it
can become law. In all cases, either chamber of Congress may block
it.

In 2010, the Patient Protection and Affordable Care Act (PPACA)
created the Independent Payment Advisory Board, or IPAB. When the
unelected government officials on this board submit a legislative
proposal to Congress, it automatically becomes law: PPACA
requires the Secretary of Health and Human Services to implement
it. Blocking an IPAB “proposal” requires at a minimum that the
House and the Senate and the president agree on a
substitute. The Board’s edicts therefore can become law without
congressional action, congressional approval, meaningful
congressional oversight, or being subject to a presidential veto.
Citizens will have no power to challenge IPAB’s edicts in
court.

Worse, PPACA forbids Congress from repealing IPAB outside of a
seven-month window in the year 2017, and even then requires a
three-fifths majority in both chambers. A heretofore unreported
feature of PPACA dictates that if Congress misses that repeal
window, PPACA prohibits Congress from ever altering an
IPAB “proposal.” By restricting lawmaking powers of future
Congresses, PPACA thus attempts to amend the Constitution by
statute.

IPAB’s unelected members will have effectively unfettered power
to impose taxes and ration care for all Americans, whether the
government pays their medical bills or not. In some circumstances,
just one political party or even one individual would have full
command of IPAB’s lawmaking powers. IPAB truly is independent, but
in the worst sense of the word. It wields power independent of
Congress, independent of the president, independent of the
judiciary, and independent of the will of the people.

The creation of IPAB is an admission that the federal
government’s efforts to plan America’s health care sector have
failed. It is proof of the axiom that government control of the
economy threatens democracy.

IPAB may be the most anti-constitutional measure ever to pass
Congress, and it is therefore tempting to dismiss IPAB as an
absurdity that the body politic will soon reject. Until that
occurs, IPAB will potentially empower just one unelected government
official to impose any tax or regulation, to appropriate funds, and
to wield other lawmaking powers.